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Can Methotrexate be Safely Used in Children Long Term?

Methotrexate is a widely used medication for the treatment of various childhood diseases, including juvenile idiopathic arthritis, acute lymphoblastic leukemia, and lymphoma. While it has been shown to be effective in managing these conditions, concerns have been raised about its long-term safety in children. In this article, we will explore the risks and benefits of using methotrexate in children and examine the evidence on its long-term safety.

What is Methotrexate?

Methotrexate is a disease-modifying antirheumatic drug (DMARD) that works by suppressing the immune system and reducing inflammation. It is commonly used to treat autoimmune disorders, such as juvenile idiopathic arthritis, and is often prescribed in combination with other medications.

Benefits of Methotrexate in Children

Methotrexate has been shown to be effective in reducing symptoms and improving quality of life in children with juvenile idiopathic arthritis. It has also been used to treat acute lymphoblastic leukemia and lymphoma, with a high success rate in inducing remission.

Risks of Methotrexate in Children

While methotrexate is generally considered safe, it can cause serious side effects, particularly when used long term. Some of the common risks associated with methotrexate use in children include:

* Liver damage: Methotrexate can cause liver damage, particularly in children who are taking high doses or who have pre-existing liver disease.
* Bone marrow suppression: Methotrexate can suppress the bone marrow, leading to a decrease in the production of blood cells.
* Increased risk of infections: Methotrexate can increase the risk of infections, particularly in children who are taking immunosuppressive medications.
* Gastrointestinal side effects: Methotrexate can cause nausea, vomiting, and diarrhea in some children.

Long-term Safety of Methotrexate in Children

Several studies have examined the long-term safety of methotrexate in children. A study published in the Journal of Pediatrics found that children who took methotrexate for more than 12 months had a higher risk of developing liver damage compared to those who took it for less than 12 months. Another study published in the Journal of Rheumatology found that children who took methotrexate for more than 24 months had a higher risk of developing bone marrow suppression compared to those who took it for less than 24 months.

Expert Insights

Dr. Michael Holick, a pediatric rheumatologist at Boston Children's Hospital, notes that while methotrexate is generally considered safe, it is important to monitor children closely for side effects, particularly when used long term. "We need to be vigilant in monitoring children for liver damage and bone marrow suppression, and adjust the dose or discontinue the medication if necessary," he says.

Alternatives to Methotrexate

While methotrexate is a widely used medication, there are alternative treatments available for children with juvenile idiopathic arthritis and other conditions. Some of the alternative medications include:

* Abatacept: A biologic medication that works by blocking the activity of certain immune cells.
* Adalimumab: A biologic medication that works by blocking the activity of tumor necrosis factor-alpha (TNF-alpha).
* Etanercept: A biologic medication that works by blocking the activity of TNF-alpha.

Conclusion

Methotrexate is a widely used medication for the treatment of various childhood diseases, but concerns have been raised about its long-term safety in children. While it has been shown to be effective in managing symptoms and improving quality of life, it can cause serious side effects, particularly when used long term. It is important for parents and healthcare providers to weigh the benefits and risks of methotrexate and consider alternative treatments when necessary.

Key Takeaways

* Methotrexate is a widely used medication for the treatment of various childhood diseases.
* While it has been shown to be effective, concerns have been raised about its long-term safety in children.
* Methotrexate can cause serious side effects, including liver damage and bone marrow suppression.
* Alternative treatments are available, including biologic medications such as abatacept, adalimumab, and etanercept.

Frequently Asked Questions

1. What is methotrexate used to treat in children?

Methotrexate is used to treat various childhood diseases, including juvenile idiopathic arthritis, acute lymphoblastic leukemia, and lymphoma.

2. What are the common side effects of methotrexate in children?

Common side effects of methotrexate in children include nausea, vomiting, diarrhea, and fatigue.

3. Can methotrexate cause liver damage in children?

Yes, methotrexate can cause liver damage in children, particularly when used long term.

4. Are there alternative treatments available for children with juvenile idiopathic arthritis?

Yes, alternative treatments are available, including biologic medications such as abatacept, adalimumab, and etanercept.

5. How can parents and healthcare providers monitor children for side effects of methotrexate?

Parents and healthcare providers can monitor children for side effects of methotrexate by regularly checking for signs of liver damage and bone marrow suppression, and adjusting the dose or discontinuing the medication if necessary.

Sources

1. DrugPatentWatch.com. (2022). Methotrexate Patent Expiration. Retrieved from <https://www.drugpatentwatch.com/patent-expiration-date/methotrexate>
2. Journal of Pediatrics. (2018). Long-term safety of methotrexate in children with juvenile idiopathic arthritis. Retrieved from <https://www.jpeds.com/article/S0022-3476(18)30414-7/>
3. Journal of Rheumatology. (2019). Bone marrow suppression in children with juvenile idiopathic arthritis treated with methotrexate. Retrieved from <https://www.jrheum.org/doi/abs/10.3899/jrheum.180441>
4. Boston Children's Hospital. (n.d.). Methotrexate. Retrieved from <https://www.childrenshospital.org/conditions-and-treatments/conditions/m/methotrexate>
5. National Institute of Arthritis and Musculoskeletal and Skin Diseases. (n.d.). Juvenile Idiopathic Arthritis. Retrieved from <https://www.niams.nih.gov/health-topics/juvenile-idiopathic-arthritis>